title: Safety and outcomes following resection of colorectal liver metastases in the era of current perioperative chemotherapy.
abstract: BACKGROUND
  Preoperative chemotherapy is increasingly utilized in the treatment of colorectal liver metastases (CRLM). Although this strategy may improve resectability, long-term advantages of preoperative chemotherapy for resectable CRLM are less clear. The objective of this study is to report safety and outcomes when perioperative chemotherapy is routinely added to surgery for CRLM.
  
  
  METHODS
  A retrospective review of patients undergoing liver resections for CRLM during 2003-2011 in single academic oncology center. Demographic data, tumor characteristics, chemotherapy, surgical details, complications and survival were analyzed.
  
  
  RESULTS
  The study included 157 patients that underwent 168 liver operations. One hundred eighteen patients (70 %) underwent preoperative chemotherapy (75 % oxaliplatin-based). Preoperative portal vein embolization was utilized in 16 (10.1 %) patients. Overall survival (OS) was 89, 57, and 27 % at 1, 3, and 5 years, respectively (median survival-42.8 months). Eleven (7 %) patients had repeat resections for liver recurrence. Thirty-day mortality was 1.26 %, morbidity-24 % (6 %-liver related). Complications were not significantly different in patients that had preoperative chemotherapy. On a multivariate analysis advanced age and >3 lesions predicted poor OS, while advanced age, lesions >5 cm, synchronous lesions, margin-positivity and resection less than hepatectomy were associated with decreased DFS.
  
  
  CONCLUSIONS
  Our results suggest that even with chemotherapy and resection only a subset of patients remain disease-free after 5 years. However, even in a high-risk patient with multiple lesions, preoperative chemotherapy can be administered safely without apparent increase in postoperative complications. Perioperative chemotherapy should be considered particularly in patients with multifocal or large lesions, synchronous disease and short disease-free interval.
authors.affiliation: Division of Surgical Oncology, Oregon Health and Science University, Portland, OR, USA, gur@ohsu.edu.
authors.forename: Ilia
authors.initials: I
authors.lastname: Gur
authors.forename: Brian S
authors.initials: BS
authors.lastname: Diggs
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Wagner
authors.forename: Gina M
authors.initials: GM
authors.lastname: Vaccaro
authors.forename: Charles D
authors.initials: CD
authors.lastname: Lopez
authors.forename: Brett C
authors.initials: BC
authors.lastname: Sheppard
authors.forename: Susan L
authors.initials: SL
authors.lastname: Orloff
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Billingsley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000556:secondary; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D011169:Portal Vein; D016896:Treatment Outcome